By Elizabeth Thompson
The team at UNC Horizons is no stranger to public health crises — the opioid epidemic has ravaged the country for over 20 years and killed thousands — but when the COVID-19 pandemic emerged in March of 2020, they were dealing with a new monster.
“The opposite of addiction is connection,” said Hendrée Jones, executive director of Horizons, a Carrboro-based program that provides substance use treatment and resources for mothers.
Feelings of isolation, fear and boredom can be triggers to return to or escalate a substance use disorder, Jones said. During the lockdown, Horizons moved all its programming online. As people felt more isolated throughout the pandemic, substance use and overdoses increased.
The spike in overdoses is in part due to the increase of fentanyl — a synthetic opioid 80 to 100 times stronger than morphine, said Elisabeth Johnson, director of medical services at Horizons.
“Fentanyl came raging onto the scene,” Johnson said. “We saw some of it a little over a year ago. I feel like we’ve just been hit with a wave in the face. It’s just a little overwhelming. And it’s also in everything. I think that’s the most upsetting piece.”
Fentanyl has appeared in substances that you wouldn’t expect, from cocaine to methamphetamine, Johnson said. Many times people using drugs are unaware the potentially lethal substance has been added in. Because fentanyl stays longer in people’s systems, it is harder to stabilize people with Medication Assisted Treatment (MAT) drugs, such as buprenorphine, methadone and naltrexone, Johnson said.
These coinciding public health crises have made fostering a recovery community for women, especially pregnant women who already face increased stigma for opioid use disorder, even more important. Horizons has a variety of programs to help women struggling with opioid use disorder, from residential programs in Chapel Hill and Hillsborough and outpatient services, prenatal and postpartum care at UNC Horizons in Carrboro and UNC Wakebrook in Raleigh.
Pregnant people struggling with opioid use disorder are often subject to stigma due to the possible effect of opioid use on their baby, even if they are on prescribed opioid addiction treatment drugs. Horizons staff explain to pregnant people about how medication-assisted treatment can help stabilize a pregnancy for both the mother and baby, said Carl Seashore, pediatrician in residence at Horizons.
While there is a chance that a baby born from a mother using MAT could experience Neonatal Abstinence Syndrome or opioid withdrawal, it is treatable, Seashore said. Pregnant people who stop using opioids completely risk experiencing withdrawal — which mimic severe flu-like symptoms — and possibly returning to drug use. The highs and lows of drug use and withdrawal also puts stress on the developing baby and could cause a miscarriage.
“Risk of relapse is very real,” Seashore said. “One of the key things that medication-assisted treatment does is suppress cravings. And so, risk of relapse is lower.”
Addiction recovery in a pandemic
When dealing with public health crises, the focus is primarily put on physical health, Jones said. But mental health is also incredibly important.
The compounding challenges of the COVID-19 pandemic and the opioid epidemic make recovery difficult, but not impossible. Horizons has had women successfully complete its recovery program virtually, Jones said.
Virtual programming is a “mixed bag,” Jones said. On one hand, the barrier of travel is no longer a problem for women who might live farther from Horizons or not have a reliable mode of transportation. On the other hand, issues like having a cell phone and a data plan became new barriers, as well as spotty broadband access in rural areas.
Susan Cole, a woman who completed Horizons’ program virtually, shared her experiences with recovery at the People’s Opioid Summit in early October. Cole was part of one of Horizons’ residential programs, which provided opportunities to interact with other women in the residence. However, all of her classes and support groups met online.
After she struggled with opioid use disorder for five years, Cole’s father dropped her off at UNC Medical Center in the throes of the COVID-19 pandemic. She was pregnant and had relapsed after five months of sobriety.
“At that point I was homeless. I was pregnant. And I was dropped off at UNC hospital emergency right in the middle of a pandemic,” Cole said in an interview with NC Health News.
She said hospital staff checked her into the emergency room from her car and then laid her on a gurney near someone who had COVID. She was devastated. She was terrified. Cole said her situation improved when her insurance was accepted at Horizons.
“I am living the recovery life as a mom,” Cole said at the summit, “Things are going really good right now, and so I’m really honored to be here. It’s nice to feel heard, as a woman who felt invisible for so long.”
But virtual recovery wasn’t without its challenges, Cole said. She had Zoom classes from 9 a.m. until around 1:30 p.m. It was isolating to be away from her family and children, but she and the other women who lived around her supported each other, Cole said.
Women at Horizons support one another with meals, gifting baby clothes or by just being a listening ear, Jones said. Participants often talk about the unexpected friendships they’ve gained through Horizons and how grateful they are for the other women in the program.
Lessons from the pandemic
The switch to virtual programming at the beginning of the pandemic was clunky for many providers, Jones said. However, Horizons missed just one day of classes.
Losing in-person connection is hard, but making sure the women in the program felt safe was paramount, Johnson said.
There are also benefits to a hybrid virtual, in-person model.
Telemedicine was an underused tool before the pandemic, Johnson said. Especially for many of the outpatient women in Horizons who live an hour or more away from its Carrboro office, where Johnson sees patients for prenatal visits.
“If you talk to most people in health care, they really liked this hybrid model,” Johnson said, “If people can get to you? Fantastic. If they can’t get to you, can we do a video visit instead? And that ties them over until they can get to you. I think most people and patients like it too.”
Telemedicine can also provide a “window into what home life is like,” Johnson said.
“You can look around, and I’ve asked people, ‘Do you have enough food? Is everything OK? Show me your refrigerator.’ Doing the kind of things that home health nurses would do,” Johnson said. “It’s kind of nice to be able to have that access to that.”
The COVID-19 pandemic triggered some people to think about using substances again, including those who had graduated from the program. However, many knew to reach out if they needed help, partially due to the program’s strong alumni network, which was a “silver lining” of the pandemic, Jones said.
As the country continues to adjust to a new normal, Jones said she hopes everyone has learned an important lesson about mental health.
“We have to prioritize mental health care just as much as we prioritize physical health care,” Jones said. “Because there are people suffering, as you can see.”
For Cole, who has been in recovery for about a year now, after five years of using opioids, it’s still an uphill battle.
“I’m back in the town that I messed up in, jumping back into my kids’ life. It’s hard paying bills. It’s just hard. It’s worth it, but it’s really hard.”
It’s “like walking into the woods,” Cole said. “You spend five years walking in, it’s gonna take a lot longer to get yourself back out.”
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It is good that we have Telehealth for a virtual consultation. Thank you for the very informative article, looking forward to more articles from you, Elizabeth.